Stewart M P, Kinninmonth A
Royal Infirmary, Glasgow, UK.
Injury. 1993 Dec;24(10):667-70. doi: 10.1016/0020-1383(93)90317-y.
Shotgun blasts may cause devastating injuries in civilian trauma practice. We have reviewed 23 consecutive patients with 28 deliberate shotgun wounds to limbs treated over a 4-year period. Wounds were categorized using the Red Cross wound classification. Twenty wounds were high-energy transfer grade 2 and 3 injuries: eight involved only the soft tissues (five category 2ST, three category 3ST), 10 wounds involved fractures (two category 2F, seven category 3F, one category 3VF), and three wounds involved major vessel injury (two category 3V, one category 3VF). Category 2ST and 3ST wounds were managed successfully with thorough wound excision of devitalized tissue, fasciotomy, and early wound closure. The more complex category 3F, 3V and 3VF wounds required a multidisciplinary approach to their management. Three lower limbs (category 3F, 3V, and 3VF wounds) with associated major nerve injury were amputated at the first operation; there were no cases of secondary amputation. Of the salvaged limbs, those with category 3F injury at or below the level of the elbow or knee had poor functional results.
在平民创伤治疗中，霰弹枪伤可能导致毁灭性损伤。我们回顾了在4年期间连续收治的23例患者，他们共有28处肢体蓄意霰弹枪伤。伤口采用红十字会伤口分类法进行分类。20处伤口为高能量转移2级和3级损伤：8处仅累及软组织（5处2级软组织伤，3处3级软组织伤），10处伤口伴有骨折（2处2级骨折，7处3级骨折，1处3级血管骨折），3处伤口伴有大血管损伤（2处3级血管伤，1处3级血管骨折）。2级软组织伤和3级软组织伤通过彻底切除失活组织、筋膜切开术和早期伤口闭合得到成功处理。更为复杂的3级骨折、3级血管伤和3级血管骨折伤口需要多学科方法进行处理。3例伴有主要神经损伤的下肢（3级骨折、3级血管伤和3级血管骨折伤口）在首次手术时被截肢；无二次截肢病例。在保肢的病例中，肘部或膝部及以下部位为3级骨折损伤的肢体功能结果较差。
